AB1261 DEVELOPMENT AND VALIDATION OF GOUT “TREAT-TO-TARGET” BOOKLET
Authors: N. Mustafa, M. R. Isa, H. Baharuddin
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Gout is a treatable disease but often sub-optimally managed. The main gaps identified in gout management are sub-optimal urate lowering therapy (ULT) adherence and lack of adequate ULT dosage.<sup>[1]</sup> Nurse-led care by providing individualized information led to a reduction in gout flares and tophi,<sup>[2]</sup> while a structured gout management programme led by pharmacists<sup>[3]</sup> resulted in a higher rate of reaching serum uric acid (SUA) compared to usual care. Most patients with gout are being managed in primary care setting where nurse-led or pharmacists-led care may not be realistic, especially in developing countries where human resources are limited. Furthermore, clinic visits for every ULT increment can be burdensome to the healthcare system and even patients. Would a booklet on gout be helpful to improve patients' education and ultimately care of patients with gout? <h3>Objectives</h3> This study was conducted to validate our newly developed Gout 'Treat-to-Target' Booklet, which was intended to document individual patient's data relevant to gout and to provide basic written information on gout, for patients' reference. <h3>Methods</h3> This methodological research was conducted following three stages; stage 1 involved the review of the Malaysian Clinical Practice (CPG) for the management of gout<sup>[4]</sup> and the EULAR evidence-based recommendations for gout management,<sup>[1]</sup> stage 2 involved adoption of the content which was written into a booklet called Gout 'Treat-to-Target' Booklet, and stage 3 was the evaluation of the booklet for content and face validity. The content validity index (I-CVI) was assessed by 11 healthcare providers who were involved in managing gout patients (four consultant rheumatologists, two general physicians and five medical officers) using a four-point Likert scale regarding relevancy, clarity, simplicity and ambiguity of each item in the booklet. A scale with excellent content validity composed of I-CVI of 0.79. The face validity index (FVI) was performed by 10 patients with gout who were asked to rate each content item independently (rating 1 and 2 represent invalid comprehensiveness and rating 3 and 4 represent valid comprehensiveness). An FVI for each item of &gt;0.79 was considered relevant. <h3>Results</h3> The size of the booklet was 148 x 120 mm, which fits into pockets of trousers. (Figure 1) It consisted of 15 printed pages (excluding the front page) and divided into two segments. The first segment would contain items related to individual patient's data related to gout such as onset of the first symptoms, onset of tophi, cardiovascular co-morbidities, the SUA target, ULT used (including the dates for dose increment), colchicine dose and SUA level at each visit. The second segment consisted of four appendices which contained basic information on gout (appendix 1: treatment options in gout, appendix 2: medication information, appendix 3: gout diet and appendix 4: recommended gout lifestyle). The I-CVI assessed by the 11 experts for all items were &gt;0.79 (minimum 0.9, maximum 1.0), while the FVI evaluated by 10 gout patients for all items were 1.0. <h3>Conclusion</h3> The development and validation process of our Gout 'Treat-to-Target' Booklet was described. This booklet achieved excellent I-CVI and FVI, and thus would be applicable in clinical practice. <h3>References</h3> [1]Richette P, Doherty M, Pascual E<i>, et al</i>. 2016 updated EULAR evidence-based recommendations for the management of gout. <i>Annals of the Rheumatic Diseases</i> 2017; <b>76:</b>29-42 [2]Murdoch R, Barry MJ, Choi HK, Hernandez D, Johnsen B, Labrador M, et al. Gout, Hyperuricaemia and Crystal-Associated Disease Network (G-CAN) common language definition of gout. RMD open. 2021;7(2):e001623. [3]Goldfien R, Pressman A, Jacobson A, Ng M, Avins A. A pharmacist-staffed, virtual gout management clinic for achieving target serum uric acid levels: a randomized clinical trial. The Permanente Journal. 2016;20(3). [4]Loh YT, Muhamad Samudi AN, Mohd Asmah, et al. Clinical Practice Guidelines Management of Gout. Second edition, Nov 2021. e-ISBN: 978-967-2887-28-7 <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.